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r <br /> COUNTY OF SAN JOAQUIN Date: �2 3 1:7— <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: ����J� <br /> APPLICANT OFFICE USE ONLY <br /> Name: UF- 109' 1c1c. ' Ct <br /> Address: O. x JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code.,/- C4- APNFEE DUE: <br /> Area Code -Telephone Number: b - 3 EXP. DATE: DRIVEWAYS: <br /> STREET: /' ,, <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: G✓�+ f- 1 f. i TYPE: <br /> Site Address: .2,SlCD7- FORMS: <br /> City, State,Zip Code: i U�,, NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: , <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The underss ned hereby applies for permission to excavate,construct and/or otherwise encroa h on County Hi hway Right-o-Way on the <br /> 16rx51' side of l„9approximately e � ilf <br /> of A:;.57/ by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10109) Pagel of2 <br />